Failure to Ensure Residents' Drug Regimens Were Free from Unnecessary Medications
Penalty
Summary
The facility failed to ensure that residents' drug regimens were free from unnecessary medications in several instances. For one resident with dementia and chronic kidney disease, an antibiotic (Bactrim DS) was administered for a urinary tract infection despite the absence of urinary symptoms and without laboratory confirmation of infection. The McGreer Criteria Checklist, reviewed by the medical doctor, DON, and infection control preventionist, indicated that the resident did not meet criteria for antibiotic use, yet the resident received twenty doses of the medication without supporting documentation. Another resident with dementia and anxiety was prescribed two antidepressant medications, Trazodone and Remeron, concurrently. The clinical record lacked documentation justifying the use of duplicate antidepressant therapy. The DON confirmed that there was no clinical justification available for this medication regimen. A third resident with PTSD and dementia received an as-needed (PRN) antianxiety medication, Ativan, on multiple occasions over several months. The facility did not limit the PRN order to 14 days as required, nor did it provide documentation of physician assessment or clinical justification for continued use. Additionally, there was no evidence that non-pharmacological interventions were attempted prior to administration of the medication. The consultant pharmacist had recommended a review and possible gradual dose reduction of psychoactive medications, but the physician's response did not provide sufficient clinical rationale for continued use. The facility was unable to provide documentation supporting the ongoing use of multiple psychoactive medications for this resident.